Cirrhosis

Overview

Cirrhosis is extensive scarring of the liver caused by long-term tissue damage due to issues like alcoholism, type 2 diabetes, hepatitis, non-alcoholic fatty liver disease and other chronic conditions. Among other functions, the liver is the body’s main blood-filtering organ. As scar tissue (AKA fibrosis) develops and replaces healthy tissue, it can begin to block blood flow through the liver, inhibiting the liver’s ability to remove toxins. Cirrhosis is considered a very advanced form of fibrosis.

Many people who suffer from cirrhosis are unaware they have the condition, since both fibrosis and cirrhosis often present without pain or other symptoms until the liver is badly scarred. Advanced cirrhosis can eventually cause liver failure, in which the liver stops working entirely, or liver cancer. The only long-term treatment for advanced cirrhosis or liver failure is a liver transplant.

Why Hoag for Cirrhosis Treatment in Orange County?

Liver damage from cirrhosis is usually permanent and can be fatal. But if the condition is diagnosed and treated before it has advanced too far, symptoms can be addressed and further damage can sometimes be prevented. That’s why evaluation and treatment by an experienced, high-volume liver program is crucial to recovery.

Facing cirrhosis of the liver? The Hoag Digestive Health Institute’s Liver Program is the most comprehensive in Orange County, offering advanced diagnosis, next generation treatment options and hope, even for those with advanced cirrhosis or liver disease. Meet Hoag’s dedicated Liver Program Team.

Medical science can’t cure cirrhosis yet. But Hoag is working toward that goal every day, and helping those with the condition live longer, healthier lives. Learn more about Hoag’s advanced treatment options for cirrhosis.

Symptoms and Causes of Cirrhosis

One of the reasons cirrhosis is so dangerous is that it usually causes no pain or other symptoms until the disease is very advanced. However, as cirrhosis begins to impact the function of the liver, serious conditions can develop. Symptoms of cirrhosis can include:

Early Symptoms:

• Unexplained drowsiness, weakness or fatigue
• Recurring nausea or vomiting
• Dark or tarry bowel movements
• Loss of appetite
• Unexplained weight loss
• A mild ache or discomfort in the upper-right of the abdomen

Advanced Symptoms:

• Bleeding or bruising easily
• Loss of muscle mass
• Unexplained confusion, memory issues or difficulty sleeping
• Edema, which is swelling in the lower legs, ankles or feet
• Ascites, which is swelling of the abdomen due to fluid buildup
• Severe, unexplained itching
• Dark-colored urine
• Jaundice, a condition which can cause yellowing of the eyes and skin
• Portal hypertension, which is elevated blood pressure within the portal vein that carries blood from the digestive organs to the liver. This increase in pressure can be caused by blockage in blood flow through the liver, including blockages caused by cirrhosis

Risk Factors

There are a number of factors that can increase your risk of developing cirrhosis. These include:

• Alcohol abuse
• Non-Alcoholic Fatty Liver Disease (NAFLD), which is a condition that can cause fat to build up in your liver, potentially damaging the tissue in a way similar to long-term alcoholism, even in those who drink little to no alcohol
• Hepatitis C
• Hepatitis B
• Autoimmune hepatitis, in which the body’s immune system attacks the liver and causes tissue damage
• Having certain inherited conditions, including Wilson disease, hemochromatosis and alpha-1-antitrypsin deficiency
• Long term use or abuse of certain medications, including anabolic steroids, erythromycin, sulfa drugs, over-the-counter painkillers containing acetaminophen and others

Diagnosis and Tests

If you visit a physician with symptoms that suggest you might have cirrhosis of the liver, your doctor will likely talk to you about your symptoms, followed by a thorough physical exam. Your doctor will also likely talk to you about your alcohol use, conditions you may have, certain medicines you might take and other factors that can harm the liver.

Depending on the outcome of the initial exam, you may be referred for further diagnostic testing. These tests may include:

• Imaging tests, which can show the size, texture, shape and stiffness of the liver (which may indicate scarring). Imaging tests may include:
  • Magnetic Resonance Imaging (MRI)
  • Ultrasound
  • X-rays
  • Computerized tomography (CT) scans
• Biopsy, in which a small sample of liver tissue is removed so it can be examined in a lab
• Blood testing, including tests for:
  • Abnormal enzyme levels that can indicate liver damage
  • Increased bilirubin, which is created when your body breaks down hemoglobin and can cause jaundice if levels are too high
  • A complete blood count, which can reveal signs of infection or anemia that might indicate internal bleeding
  • Testing for hepatitis B and C

Advanced Imaging and Diagnosis of Cirrhosis at Hoag

Cirrhosis of the liver is a silent assailant, often not discovered until the condition has reached a crisis level. With that in mind, you need a team that can hit the ground running, with advanced imaging that can pinpoint areas of concern and chart a strategy for halting further damage as fast as possible. You’ll find that and more at Hoag.

At the Hoag Digestive Health Institute, advanced diagnostics for those facing cirrhosis and chronic liver disease include:

• FibroScan^®, (AKA transient elastography), which is the first FDA-approved device in the U.S. that provides a painless, non-invasive method of testing for liver scarring and cirrhosis without the side effects and complications of a needle biopsy. Learn more about FibroScan^®.
• Hepatobiliary iminodiacetic acid (HIDA) scanning, which is an advanced imaging technique which utilizes an injected radioactive tracer to diagnosis issues with the liver, gallbladder and bile ducts
• Attenuation Imaging (ATI) for Fat Quantification, which is an imaging technique used for quantifying fat deposits in the liver in real time
• Magnetic Resonance Cholangiopancreatography (MRCP), which utilizes powerful magnetic fields, radio waves and advanced computing to evaluate the gallbladder, liver, bile ducts, pancreas and pancreatic duct for disease, without the use of ionizing radiation
• Magnetic Resonance Elastography (MRE), which is used to detect stiffening of the liver caused by scarring and inflammation. This technology combines MRI imaging with low-frequency vibrations to create a visual map called an elastogram that shows the degree of stiffness of body tissues.
• Magnetic Resonance Multi-Echo Dixon Vibe Liver Iron Quantification, which is a 3D imaging technique used to simultaneously assess fatty liver disease (AKA steatosis) and abnormal iron levels in patients with chronic liver disease.
• Magnetic Resonance Proton Density Fat Fraction (MRI-PDFF), which is an emerging imaging technique that accurately measures the amount of fat in liver tissue by correcting factors that can degrade or skew magnetic resonance signal intensity

Management and Treatment for Cirrhosis

While the search for treatment options is advancing every day, there currently is no way to cure cirrhosis or reverse the damage and scarring caused by the condition.

Doctors can, however, help you take steps to stop the progression of the disease, manage or treat conditions like hepatitis or Type 2 diabetes that may have caused liver damage, or treat the symptoms cirrhosis can cause.

Your doctor may also suggest changes in diet, including having you stop drinking alcohol, limit your intake of fats or protein, and/or avoid eating undercooked fish, shellfish and meat due to the risk of serious infection. In cases of severe cirrhosis and liver failure, you might be a candidate for a liver transplant.

Explore clinical trials for liver disease and cirrhosis at Hoag.

Prevention

Ways to detect cirrhosis early or reduce your risk of developing cirrhosis may include:

• Use alcohol in moderation, and seek treatment for alcohol abuse
• Eat a healthy, balanced diet that’s low in fat and salt
• Cut back on the amount of salt you eat
• Maintain a healthy weight
• Get vaccinated against hepatitis B
• Get regular checkups, including blood work that can suggest changes in liver function
• Use over-the-counter medicines as directed, being particularly careful when taking non-steroidal anti-inflammatory drugs such as ibuprofen, aspirin, acetaminophen and other pain medications
• Take steps to manage chronic conditions that can impact liver function, including Type 2 diabetes, high blood pressure and hepatitis A and B

Treatment for Alcoholism at Hoag

For those with alcohol addiction that may be contributing to cirrhosis or liver disease, Hoag is here for you. The longest-standing addiction treatment option in Orange County, Hoag Addiction Treatment Centers is an accredited program within the Pickup Family Neurosciences Institute that offers help, hope and healing for people and families facing addiction to alcohol and other drugs. For more information, visit this link, or call 949-764-6883.